| NPI | 1619783362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATELIN TALBERT Owner/Provider 410-726-7691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2024-12-07 |
| Last Update Date | 2024-12-07 |